Our healthcare and business law firm consistently works with physicians who are dealing with complications resulting from adverse reporting to the National Practitioner Data Bank (“NPDB”). Certain entities, including medical licensure boards and medical malpractice payers, have a duty to report specific actions or events to the NPDB. Any practitioner who has had the misfortune of having an action reported to the NPDB is likely aware of the negative impact such a report can have on his or her ability to practice. Sometimes, however, the information reported to the NPDB is inaccurate in whole or in part. Inaccurate or incomplete reports can have equally serious adverse impacts on a medical provider’s ability to practice as any correctly submitted NPDB report. This post outlines steps practitioners or counsel can take to help minimize the adverse impact of such inaccurate reports. If you have a question about the NPDB or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, email@example.com. You may also learn more about our law firm by visiting www.hamillittle.com.
Submitting a Statement
The NPDB allows practitioners to submit statements at any time to explain or supplement a report. According to the NPDB, the statement is the provider’s “opportunity to provide additional information [the provider] would like included with the report.” A statement does not correct or void a reporting by a medical board, but it is a useful tool for a provider to explain an adverse licensure action when that is necessary. This is a way to tell the practitioner’s side of events. Although the statement may be limited in its impact, it can be particularly useful to submit a well-drafted statement while waiting for the often-lengthy dispute resolution process to conclude. Statements can also be submitted or edited at any time, so the efficiency of a statement makes it a useful tool.
Disputing the Report
If the practitioner wishes to take the matter beyond submitting an explanatory statement, the practitioner must make an important decision: work through the NPDB or go straight to the source (the reporting organization). In our business and healthcare law firm’s experience, we have had more success working with the reporting entity directly to resolve reporting disputes. In fact, the NPDB directs providers to contact the reporting organization before initiating a formal dispute with the NPDB.
Working with the Reporting Organization
As an initial matter, it is important to know what the reporting organization can do to fix an inaccurate report. Each reporting organization has the ability to submit four types of reports: an Initial Report, a Correction Report, a Void Report, and a Revision-to-Action Report. An Initial Report is easy enough to understand and, in the circumstances discussed within this article, is usually the cause of the dispute. A Revision-to-Action Report is relevant when there has been a subsequent action to the Initial Report, such as a probationary period ending. The Initial Report and the Revision-to-Action Report both appear on the practitioner’s records, which means the inaccurate reporting is not removed. When dealing with an inaccurate report that the practitioner wishes removed from his or her record, the relevant reports are generally going to be a Correction Report and Void Report.
A Correction Report is appropriate if there is an error or omission in a previously submitted report. In this case, the reporting organization can file an updated and corrected report. The Correction Report takes the place of the Initial Report, removing the Initial Report from the disclosable record. The corrected report will, however, reflect that it is a “corrected” report. Correction Reports are easily and routinely submitted and are submitted in largely the same way all reports are submitted through the NPDB’s Integrated Querying and Reporting Service (IQRS) system, following the prompts to file a correction report. A Void Report is simply a withdrawal of the subject report in its entirety. A Void Report is appropriate if the report was submitted in error, it is not reportable under reporting requirements, or the action was overturned.
Using the NPDB’s Dispute Process
If the practitioner or his or her attorney are unsuccessful in persuading the reporting organization to correct the record by filing an appropriate report, the practitioner can initiate a dispute with the NPDB directly. The NPDB has sixty days to resolve the dispute with the reporting organization. If the practitioner is unhappy with the outcome of that process, the practitioner can request to go through the dispute resolution process, which is essentially a request for review by the U.S. Department of Health and Human Services. Success through the NPDB’s dispute process is limited. In our experience, success is more likely when working with the reporting organization.
If you have a question about the NPDB or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, firstname.lastname@example.org. You may also learn more about our law firm by visiting www.hamillittle.com.